Oncology & Hematology Coding Alert

Question: In the December 1999 issue of Oncology Coding Alert, the Correctly Code Epoetin-Alpha article, you indicate that proper coding is 96410 [infusion technique, up to one hour] and +96412 [infusion technique, each additional hour]. I thought a subcutaneous injection should be billed as 96400 [chemotherapy administration, subcutaneous or intramuscular, with or without local anesthesia]. Please clarify.

Kara Castro,
Hematology and Medical Oncology, PC
Brooklyn, New York

Answer: The subcutaneous injection code billed for epoetin alfa may vary depending on the insurance company. The provider may bill 90782 (therapeutic, prophylactic or diagnostic injection [specify material injected]; subcutaneous or intramuscular), if the injection is the only service provided. If any other evaluative or patient management services are provided, an evaluation and management code (99211-99215) can be billed. Both 90782 and E/M services cannot be billed on the same day. Proper coding for epoetin alfa for non-end-stage renal disease, such as chemotherapy induced anemia, will be billed according to the policy of the insurer. Each Medicare carrier has specific guideline for epoetin alfa billing. Please refer to your local carriers guidelines for proper coding and billing. You can also contact PROCRITline at (800) 553-3851 to speak with a reimbursement specialist.

Editors note: This question was answered by Roberta Buell, MBA, president of Documedics, a reimbursement-consulting firm based in San Bruno, Calif., Ortho Biotech, which markets epoetin alfa under the trade name Procrit.